From the Research
The recommended management for a swelling at the floor of the mouth is to perform a modified micro-marsupialization, especially in pediatric patients, due to its low invasiveness and very low relapse rate, as supported by the most recent and highest quality study 1. When managing a swelling at the floor of the mouth, it is crucial to first determine the underlying cause through a thorough clinical evaluation, including imaging studies like CT or MRI.
- The differential diagnosis for floor of mouth swellings includes ranula, salivary gland stones, infectious causes like Ludwig's angina, and other less common conditions such as vascular malformations or tumors.
- For ranula, a mucous retention cyst, modified micro-marsupialization is strongly indicated and recommended, especially in pediatric patients, due to its effectiveness and low risk of complications 1.
- Infectious causes like Ludwig's angina require prompt administration of broad-spectrum antibiotics, such as amoxicillin-clavulanate or clindamycin, for 7-10 days, along with possible surgical drainage if abscess formation is present.
- Salivary gland stones may be managed with sialagogues, warm compresses, and analgesics like ibuprofen for mild cases, while larger stones often require surgical removal.
- Life-threatening swellings require immediate airway assessment and possible intubation or tracheostomy.
- Patients should be advised to maintain good oral hygiene, stay well-hydrated, and seek immediate medical attention if they experience difficulty breathing, swallowing, or speaking, as floor of mouth swellings can rapidly compromise the airway due to the confined anatomical space and proximity to critical structures, as discussed in various studies 2, 3, 4, 5.